“These visits are not part of a listening tour,” said President Begaye. “We set up the visits to establish communication between the facilities, departments, congressional representation and myself, so that we can address these issues at a higher level.”

The congressman toured the Tuba City Regional Health Care Corporation (TCRHCC) and met with TCRHCC CEO Lynette Bonar who said the facility’s senior leadership is comprised of 70 percent Native Americans, primarily Navajo.

Bonar would like to see health care service improve throughout the community through health education.

“We do more than just primary care,” she said. “We also do public health and environmental care.”

The CEO said TCRHCC receives referrals from Hopi Health Care, Kayenta Health Center and the Chinle Comprehensive Health Care Facility. According to Bonar, if TCRHCC weren’t in place, a lot of patients would have to travel further south for health care.

“The Flagstaff Medical Center cannot absorb the overflow of patients from the Navajo Nation,” she said. “If we didn’t take the 140 patients referred, those patients would have gone south. We capture this funding. In 2015, TCRHCCC received 371 inpatient admission from these areas.”

For TCRHCC, an Indian Health Service funding agreement covers 33 percent of their budget, third-party reimbursements cover 65 percent and grants make up the final two percent.

Bonar sees the need for fiber optic line to be put in to increase reliable intranet connections within the health care facility. Faster and more reliable intranet connection would contribute to improved efficiency, greater training opportunities and advancements in telemedicine.

Through Navajo Tribal Utility Authority this will cost $2 million dollars, she said.

The CEO advocated for a specialized treatment facility addressing oncology and cancer care. The high occurrences of uranium contamination in the area dictate this need.

“The infrastructure bill that is coming forward will have broadband in it,” Congressman O’Halleran told Bonar.

The congressman said Bonar’s information was useful in assessing the needs of the area to take back and present to Congress.

President Begaye and Congressman O’Halleran toured the DaVita Dialysis Center and spoke with Facility Administrator Will Curley about the challenges that DaVita faces in servicing the regional area. The major challenges, according to Curley, are maintaining nursing staff, housing, Medicare reimbursements and access to patient transportation.

The Tuba City DaVita facility has five nursing positions with two positions currently vacant.

“Lack of housing available for staff is an issue. We need more housing in the area. It’s very rural here and if we can keep a nurse here for two years, that’s really great. It’s hard to keep staff here,” Curley said. “Many have to travel in to work at our facility.”

Patients also face issues of distance. Curley said the Tuba City DaVita’s coverage area spans from Page to Polocca and sometimes even as far as Chinle.

“Some of our patients travel two hours to get here. They come for a four-hour treatment, then they travel two hours to get home. That’s a whole day for them,” he said.

Only patients with full Medicaid benefits have transportation provided to them. Patients who only have Medicare without any supplemental insurance face transportation dilemmas.

Curley estimated that out of 101 patients, possibly 75 have Medicare and about 50 patients have both Medicare and Medicaid. Medicare alone only pays 80 percent. If a patient loses eligibility for Medicaid, they lose eligibility for transportation.

“Which means we have to find transportation for them,” Curley said.

The administrator also said the facility takes reimbursement cuts on patients with only Medicare benefits which amounts to $10,000 a monthly loss.

“Reimbursement for Medicare for our treatment services is about $250 dollars. Average treatment costs about $2,000 dollars,” he said. “Having patients with commercial policies helps offset the cut we take.”

Curley addressed coverage concerns to emphasize financial obstacles the dialysis center faces in servicing the community. DaVita has insurance counselors who work with their patients to make sure they are 100 percent covered.

Hearing about concerns firsthand from staff of the Tuba City Regional Health Care Corporation and DaVita Dialysis Center highlighted the “difficulties of life on the Navajo Nation,” Congressman O’Halleran said.

“We’ve been looking forward to coming out and working in a closer relationship so that the lines of communication are consistent,” the congressman said.

President Begaye thanked Congressman O’Halleran and his staff for visiting Tuba City and for listening to the issues and concerns of staff who provide critical health service to the Navajo people.

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